Reaching, Linking and Engaging Women in HIV Care. Victoria A Cargill, M.D., M.S.C.E. Office of AIDS Research NIH. Disclosures of Financial Relationships. This speaker has no significant financial relationships with commercial entities to disclose.

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"Stigma remains the single most important barrier to public action. It is a main reason why too many people are afraid to see a doctor to determine whether they have the disease, or to seek treatment if so. It helps make AIDS the silent killer, because people fear the social disgrace of speaking about it, or taking easily available precautions. Stigma is a chief reason why the AIDS epidemic continues to devastate societies around the world."1

The correlation between missed visits and increased patient death is high. Mugavero et al. CID 2009;48:248-56

Increased HIV testing

The CDC recommends opt-out testing for those age 13 – 64. Testing should be done in a routine visit unless the patient specifically refuses testing.

Systematic follow up of missed visits

Several studies and a recent abstract presented at the AIDS 2012 meeting demonstrate the importance of following up missed visits. Over 1/3 who truly had dropped out returned to care on a follow up contact. Biggest reason for failing to return – the patient felt well.

Many women with HIV infection have already experienced racism,discrimination and more expecting it to get worse with HIV care. Having culturally competent care is essential.

Dionne-Odom et al. 2009. HIV/AIDS In U.S. Communities of Color.

Ongoing screening for intimate partner or other violence/abuse, mental health and substance use. This is not a “one and I’m done”

Mental health screening has to be done utilizing tools that are culturally appropriate. Beck Depression Index may not be appropriate for all non-Caucasian populations. For example the CES-D (Center for Epidemiologic Studies) Depression scale has been evaluated in Latinos. (Posner et al. Ethnicity and Health 2001.)

Screening for violence needs to be on an ongoing basis as the patient circumstances can change. Three brief screening questions have been shown to be good at picking up IPV. (Feldhaus et al. JAMA. 1997;277(17):1357-1361)

Access to testing and care – depending upon where they live this can raise the specter of adult notification or being informed of their behavior. Young MSM, especially black MSM have high rates of infection and low rates of awareness.

Developmental stage - at this life stage feelings of being immortal and invulnerable can interfere with the ability to fully grasp the seriousness of the infection. Similarly, feelings of shame and fear can lead to hiding infection – including from partners – i.e. nondisclosure.

Transitions – one of the most difficult transitions is from pediatric to adult care and where many adolescents are lost in HIV care. It is essential to have a planned transition with checks to ensure that the transition is moving smoothly. As the definition of adolescence has expanded to include up to age 25, many teens can remain in care with their original provider if the practice allows.